食管癌放疗后的主动脉瘘

探讨食管癌放疗后主动脉瘘形成机制、先兆症状及预防措施。材料与方法食管癌放疗后发生食管─主动脉瘘并经尸检证实的１２例临床和病理资料分析。结果瘘均发生在放疗后１４个月内。瘘前先兆症状有剧烈胸背痛、低热、白血球数增高，Ｘ片上有明显穿孔征象。病理检查癌瘤仅侵及主动脉壁外膜层，但主动脉内、中、外膜三层均有明显炎症反应。结论放疗后的主动脉瘘与残存癌有关，但最终引起穿孔的直接原因是癌瘤合并的炎症。故有先兆症状的病人，应考虑积极抗炎治疗。

Aortoesopbageal fistula after radiation therapy for esophageal carcinoma : an analysis of 12 patients

Purpose To study the mechanism of aortoesophageal fistula formation its prodromal symptoms and preventive measres . Materials and Methods 12 patients with aortoesophageal fistula formed within 14 months after radiation therapy for esophageal carcinoma were studied histo - pathologically on autopsy . Results The prodromal symptoms before fistula formation were : severe and protracted pain in the chest and/or back, low grade fever, high WBC count and signs of esophageal perforation by barium esophagography . Autopsy specimen study showed that cancer invasion has been formed only in the adventitia, not yet in the media or intima . Inflammatory reaction or necrosis. involved the entire thicknese of the aorta wall. Conclusion the aortoesophageal fistula is often accompanied with residual or recurrent esophageal cancer but the fistula formation is triggered by inflammation of the aortic wall . Therefore, patients with prodromal symptoms of aortoesophageal fistula should be immediately and energetically treated with antibiotic therapy for a possible prevention .